Lazy eye treatment

Amblyopia or lazy eye is the condition affecting 4% of the general population wherein one eye has less vision than the other. It is usually detected on school vision screening or following a routine visit to the optician. It is usually silent but may be associated with a squint in some cases. Confusingly, a squint or misalignment of the eyes or a droopy eyelid (ptosis) may be referred to as a lazy eye as well. It is important to differentiate between these and this page deals exclusively with amblyopia.

The causes of amblyopia can be:

  • Difference in the power of the two eyes: If the refractive power of the two eyes is significantly different e.g. if one eye has a high minus or plus power, the brain prefers to use the other or normal eye to see and the development of the eye with the high error lags behind.
  • Squint or strabismus: Some children may be born with or develop a squint that leads to the eyes being misaligned. As a result, when one eye looks straight ahead the other may be turned in or outwards. If this is a constant phenomenon it leads to poor vision in the deviating eye.
  • Stimulus deprivation: This occurs when the vision out of one (or both) eyes is reduced temporarily by a cataract, droopy eyelid etc. in childhood. This leads to an unequal signal to the brain from the two eyes and as a result the eye with the worse vision lags behind even when the problem is removed.
  • Treatment of amblyopia: The principle behind amblyopia treatment is holding back or penalizing the good eye to allow the eye with the worse vision to develop better. Treatment should be instituted as soon as possible after diagnosis and works well before the age of seven. The treatment methods include:
  • Patching of the good eye: This can be carried out between half and hour to three hours a day depending on the severity of the amblyopia. Recent reports suggest that a maximum patching time of two hours is sufficient for most moderate cases.
  • Drops: In children unable (or unwilling) to patch, drops can be used to blur the vision on the good eye on a semi permanent basis. This has the advantage of avoiding a patch that some children find embarrassing to wear in public and has been shown to be as good as patching in most cases.

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